Session 5 : Health , education , and poverty

Starr began by describing four "encumbrances of history" that have shaped delivery of health care in America. One he termed the "welfare piggyback," referring to the channeling of governmental health services for the poor through public assistance rather than through a universal social insurance system or a national public health service, the two systems employed in Europe. The social insurance programs initiated during the New Deal offered income replacement for the unemployed and the elderly, not health care. Concern over the medical needs of the aged led to passage in 1965 of Medicare, an insurance program for those over 65. Its companion program, Medicaid, was set up as a form of public assistance offering medical services only to certain "deserving" groups: the blind and disabled, the aged not covered by Medicare, and AFDC recipients. Left out were two-parent families and single adults who were neither aged nor disabled, regardless of how poor they were. In consequence,